<div class="shopee-popup-form shopee-popup-form--credit-card">
  <div class="shopee-popup-form__header">
    <div class="shopee-popup-form__title">Tambah Kartu Kredit Baru</div>
  </div>
  <div class="shopee-popup-form__main">
    <div class="shopee-popup-form__main-container">
      <div class="shopee-popup-form__server-error"></div>
      <div class="_2FTWh8">
        <div class="_2syZgE"><input class="_3FAIsa" type="text" placeholder="Nama Tertera di Kartu" value=""></div>
        <div></div>
      </div>
      <div class="input-credit-card">
        <div class="input-credit-card__input">
          <div class="_2FTWh8">
            <div class="_2syZgE lLictc"><input class="_3FAIsa" type="text" placeholder="No. Kartu Kredit" maxlength="19"
                value=""></div>
            <div><span class="_3o6Z5s shopee-modal__transition-enter-done">Mohon isi di kolom berikut</span></div>
          </div>
        </div>
        <div class="input-credit-card__logo-wrapper"><span
            class="input-credit-card__logo input-credit-card__logo--visa input-credit-card__logo--grey"></span></div>
        <div class="input-credit-card__logo-wrapper"><span
            class="input-credit-card__logo input-credit-card__logo--mastercard input-credit-card__logo--grey"></span>
        </div>
        <div class="input-credit-card__logo-wrapper"><span
            class="input-credit-card__logo input-credit-card__logo--jcb input-credit-card__logo--grey"></span></div>
        <div class="input-credit-card__logo-wrapper"><span
            class="input-credit-card__logo input-credit-card__logo--amex input-credit-card__logo--grey"></span></div>
      </div>
      <div class="row">
        <div class="col-xs-6">
          <div class="shopee-popup-form__subheader">
            <div class="shopee-popup-form__subheader-text">Kadaluarsa pada</div>
          </div>
        </div>
        <div class="col-xs-6">
          <div class="shopee-popup-form__subheader">
            <div class="shopee-popup-form__subheader-text">CVV</div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-xs-6">
          <div class="_2FTWh8">
            <div class="_2syZgE lLictc"><input class="_3FAIsa" type="text" placeholder="MM/YY" maxlength="5" value=""></div>
            <div><span class="_3o6Z5s shopee-modal__transition-enter-done">Tanggal Kedaluwarsa Tidak Sah</span></div>
          </div>
        </div>
        <div class="col-xs-6">
          <div class="_2FTWh8">
            <div class="_2syZgE"><input class="_3FAIsa" type="text" placeholder="000" maxlength="4" value=""></div>
            <div></div>
          </div>
        </div>
      </div>
      <div class="_2FTWh8">
        <div class="_2syZgE"><input class="_3FAIsa" type="text" placeholder="Alamat Tagihan" maxlength="1000" value="">
        </div>
        <div></div>
      </div>
      <div class="_2FTWh8">
        <div class="_2syZgE"><input class="_3FAIsa" type="text" placeholder="Kode Pos" maxlength="100" value=""></div>
        <div></div>
      </div>
      <div class="shopee-popup-form__message">Kami bekerja sama dengan NicePay untuk memastikan bahwa informasi kartu
        kredit Anda tetap terlindungi. Shopee tidak akan mengakses info kartu kredit Anda.</div>
    </div>
  </div>
  <div class="shopee-popup-form__footer"><button class="cancel-btn">Nanti Saja</button><button type="button"
      class="btn btn-solid-primary btn--s btn--inline khi9AY" aria-disabled="false">OK</button></div>
</div>